Procon debate Should synthetic colloids be used in patients with septic shock 英文参考文献.docVIP

Available online /content/13/1/203 Review Pro/con debate: Should synthetic colloids be used in patients with septic shock? James Downar1 and Stephen E Lapinsky2 1Divisions of Critical Care and Palliative Medicine, Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto M5G 1X5, Canada 2Intensive Care Unit, Mount Sinai Hospital, 600 University Ave, Toronto M5G 1X5 and Interdepartmental Division of Critical Care, University of Toronto, 30 Bond Street, Toronto, M5B 1W8, Canada Corresponding author: Stephen E Lapinsky, stephen.lapinsky@utoronto.ca Published: 29 January 2009 Critical Care 2009, 13:203 (doi:10.1186/cc7147) This article is online at /content/13/1/203 ? 2009 BioMed Central Ltd Abstract tain more molecules of HES for a given concentration and thus have a higher oncotic pressure, but they have a shorter half-life in vivo because they are more quickly broken down by serum amylase to 50-kDa molecules that can be excreted in the urine. Solutions are typically divided into three weight You have recently heard reports that synthetic colloids may be associated with renal failure and other morbidities in certain popu- lations of critically ill patients. You have been asked by the hospital chief of staff whether there should be a suspension of the use of synthetic colloids until further information is available. You need to make a decision. categories: high MW (approximately 450 kDa) (for example, Hespan?), medium MW (200 to 260 kDa) (for example, HemoHES ? and Pentaspan ?), and low MW (70 to 130 kDa) (for example, Voluven?). Statement for debate ‘Until further data are available, synthetic colloids should not be used in critically ill patients with sepsis.’ To slow metabolism by amylase, HES molecules have hydroxyethyl radical groups substituted onto individual Introduction glucose units. The degree of hydroxyethyl substitution is expresse